SLR - November 2012 - Steve M Czymbor
Reference: Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE. (2012). The Effect of Modified Broström-Gould Repair for Lateral Ankle Instability on In Vivo Tibiotalar Kinematics. Am J Sports Med, 40 (9), 2099-2104. DOI: 10.1177/0363546512454840
Scientific Literature Review
Reviewed by: Steve M. Czymbor, DPM
Residency Program: Columbia St. Mary’s, Milwaukee, WI
Podiatric Relevance:
Ankle sprains comprise up to 23 percent of all sports injuries. This is most commonly an inversion type injury, compromising the lateral ligamentous structures. Chronic lateral ankle instability has been shown to have increased risk of early-onset osteoarthritis. This study specifically looks at in vivo repair kinematics for a Broström-Gould ligamentous repair, as opposed to previous studies on cadaveric specimens, giving a more accurate picture of this type of repair in vivo on a quasistatic weight-bearing loading.
Methods:
Patients were evaluated in a foot and ankle specialty orthopaedic clinic and determined to have unilateral, lateral ankle instability and consented for a Broström-Gould repair. All patients had a previous ankle sprain treated non-operatively for at least six months, positive clinical signs of instability, and positive lateral ankle ligament injury as determined by MRI. Patients were excluded if they had a concurrent osteochondral lesion or peroneal tendon pathology. Repair was done with bone anchors, repairing the CFL if visually damaged during surgery. Kinematic imaging was performed preoperatively and 12 months postoperatively with incremental increases in body weight; measurements were focused on anterior-posterior translation and internal-external rotation of the talus on the tibia.
Results:
There were a total of seven patients that met inclusion criteria: three men, four women. The average patient age was 37 years old, five patients with both ATFL and CFL injury as determined by MRI and surgically. Statistically significant differences in movement were found for anterior translation and internal rotation for pre- and postoperative measurements at 75 and 100 percent body weight. There was no significant difference from postoperatively repaired ankles and the contralateral intact ankle in regards to movement in the planes measured.
Conclusions:
This study helps to validate an anatomic repair utilizing the Broström-Gould technique in regards to talar movement in relation to the tibia for a quasistatic weightbearing loading kinematic model. Repair of an ankle with chronic lateral instability brings talar movement in close approximation to the non-affected side.